ObGyn Test & Discussion | INI CET Important Topics | INI CET Preparation | INI CET RDx Season 4

追加: 2026-05-12

[00:00:00]Recording in progress.

[00:00:02]>> Fibroid type was confusing. Yes, we'll discuss that today. The figure classification of fibroid. Yes, we'll discuss it today. Good to start. Yes.

[00:00:12]So, let's start with the session.

[00:00:16]First question. Yes.

[00:00:19]So, you can tell me the answer as we go along as well. So, this is again a basic question from the physiological changes which is there. They are asking you to arrange it in the correct order. So, what happens first? Initially you have proliferative phase followed by the secrettory phase in between you have ovelation which is happening. So they have given this secretary endometry which is in secretary phase rise in basal temperature midcycle surge of LH spin back of cervical mucus. Now you got something which is in proliferative phase. Pick that first one. The fourth one is spin bite which is mainly under influence of estrogen. Afterwards what will happen? You have only even such questions where you need not arrange it completely. Just look at the options which are having these first answer.

[00:00:59]There are only two options A and C. Yes.

[00:01:01]The next one is basically you have to choose three or two which is coming next. So three is the mid cycle LSH and two is basically rise in body temperature. What will happen first?

[00:01:12]First you will have midcycle LSH. See I did not even go through the entire options with these two point itself. You can easily come to the answer. You are not writing a theory exam. Do smart work. Yes. Use less time as such and come to the answer quickly. Now the next answer is midcycle l surge. After l surge there is ovelation happening.

[00:01:30]After oation there is rise in the body temperature which happens. After rise in body temperature next you are going to see this secrettory phase where there are secrettory changes in endometrium.

[00:01:41]Finally you have p progesterone level which happens 8 days post ovelation. So in your questions also when you have so many things to arrange it just look at the initial ones mostly by ruling out it will only help you then you only have to verify is this order correct or not you just go through the other orders other options which is given and just come to the answer is this answer clear to everyone first one think of proliferative phase what is happening next what is happening in ovelation finally what happens in secretary phase same thing we are going to arrange in the correct order simple question from the physiology of menration as such Next when you look at this question the next question is so main thing key points are written over here spin bar midcycle surge of LH basal body temperature secretary endometrium and finally peak progesterone levels which is reached now in the next question in the management of a patient who has uncontrolled postpartum hemorrhage all of the following arteries may be surgically liated except what do you do in this stepwise utrine devascularization as we discussed test yesterday one uterine artery other uterine artery ovarian artery other ovarian artery and anterior division of internal iliac artery we don't like the posterior division the posterior division mainly supplies the lower limb there will be eskeemia and necrosis of the lower limb as do not choose that either common iliac or posterior division of internal iliac artery yes we don't even like the external iliac also anterior the common iliac has external internal iliac we only like the anterior division of internal iliac artery do not liate the posterior division.

[00:03:22]Next moving to this question. In this a 34 year old female has presented in vaginal delivery there is difficulty to deliver the shoulder. What are we dealing with? Shoulder dystocia.

[00:03:33]Immediately the maneuver that is shown here is performed. They are asking you which anatomical change produced by this maneuver is going to facilitate the delivery. What will happen in this? The the step that you are seeing here is microberts maneuver associated with the supra pivic pressure. Whenever you are doing this macro maneuver the pelvis slice slightly shift upwards. There is sephal head rotation of pubic symphysis and along with that the sacral curvature will become more straight as it is rotating upwards. So it is sephal head curvature as well as straightening of the sacrum. We already saw the stepwise management of shoulder dystocia starting with initial call for help. Next was macroverse maneuver followed by the supra pivic pressure. Then you had these various internal rotational maneuvers that is the internal rotation manual either the wood cork screw or the rum followed by delivery of posterior arm.

[00:04:30]Finally position her in gasket position then the destructive maneuver. We have seen this stepwise in the LFT sessions also yesterday. Yes. All right. Okay.

[00:04:41]I'm glad that all of you got this answer correct. Answer is B. Yes. I'm glad that Obsang is feeling busy. Yes, that's good. So, this is your Mc Robert's maneuver that you're appreciating. Yes.

[00:04:53]In the next question, a 26 year old has presented in the gynecology department.

[00:04:59]She's complaining of irritability, anxiety, breast tenderness, blotting and it is usually one to day two days prior to onset of menration. We have discussed this yesterday. What is this PMS?

[00:05:10]Premenstrual syndrome. I told you in PMS initially I start with lifestyle modification but if it is affecting her quality of life the main drug that you can give for her is SSRI such as fluoxetic SSRI like fluoxetic first is lifestyle modification all the dietary changes all what we discussed yesterday followed by SSRI if it is affecting her quality of life like fluo set any doubts or questions so Huh? Yes.

[00:05:42]Direct question as PMS can come. Usually they ask the management aspect of it.

[00:05:47]No. Yes.

[00:05:50]The next question they're asking you the figure depicts the plasma progesterone level across a normal ovulatory menstrual cycle. Which among the following best describes X? What is X?

[00:06:02]At X you basically see the maximum level of progesterone. Indirectly they asking you when do you get the maximum level of progesterone it is 8 days post oation nearly day 22 here it is 21 is the best answer that you can choose among this day 21 yes day 21 uh malika cl forms yes exactly the corpus lutium forms this progesterone maximum is 8 days post ovelation spinbar ma'am is spinbar same as furning of cervical mucus no dear Both are under influence of estrogen. Spinbar heat is when you take the cervical mucus between the glass lights. It becomes thin easily stretchable that is spin bark. In fing there is crystallization of sodium chloride crystals which lead to that fern kind of pattern which is there. The fern kind of pattern we had seen the images of both. One is fing where there's crystallization of sodium chloride and there's fern kind of pattern. Other one they will give you that glass-like image where the cervical mucus becomes very thin and easily stretchable. Thin and easily stretchable.

[00:07:11]All right, moving ahead to the next question. A 28-year-old paran living one has a coppery inserted 2 years ago. Now she presents in the OPD on an exam on on the speculum examination. IUCD thread is not visible and ultrasound is shown that ultrasound is showing that copper is partially extending into the abdominal cavity.

[00:07:34]What is the most appropriate method to remove the se? So basically they are giving you a case of IUCD which has perforated and gone into the abdominal cavity. What do you do in this? Anything that has gone into abdominal cavity initially I will do a laparoscopy. I will try removal of IUCD. If laparoscopy is not possible, laparottomy. We have discussed the scenario yesterday. Any patient with my missing IUC, the investigation of choice is ultrasound.

[00:08:01]Then after ultrasound, if you get a perforated IUCD, go for laparoscopic removal of IUCD. Yes, correct answer here is D.

[00:08:12]Yes, if it is within uterine cavity, if removal is needed, then you can even go for hyroscopy removal or even an IUCD hook can be used. We have a small instrument with a hook like this which is used to hook this IUCD and bring out its stem if required. If it has perforated gone into abdominal cavity then you go for laparoscopy and removal.

[00:08:35]So this next question is based on identifying the type of deceleration that you are seeing. If you look at this image both are not mirror image. The deceleration is starting after onset of contraction. Maximum level is at the peak or maximum level is nearly by the end of contraction and the deceleration is persisting even after ending of contraction. This type where there is a phase shift this is basically a late deceleration.

[00:09:03]This is basically a late deceleration and as we discussed late deceleration is associated with utrop placententral insufficiency. In head compression you will have mirror images where you get early deceleration whereas umbilical cord compression you have variable deceleration which is associated. One final thing you can get sinosoidal pattern sine wave kind of pattern.

[00:09:26]Sinosoidal pattern is associated with fetal anemia.

[00:09:34]It is associated with fetal anemia. sinosoidal pattern is associated with fetal anemia. Have a note of this point as well. They can even give you examples of fetal anemia.

[00:09:46]They not directly give you fetal anemia.

[00:09:48]They can give you causes of fetal anemia such as Rh negative pregnancy or even infection with paro virus.

[00:09:59]Any cause of anemia can lead to this sinosoidal pattern. So these are the various types of deceleration. Early mirror image head compression late there is a phase shift utiliz insufficiency variable no relation c compression you can see the three different patterns here as well important image based question now let's move to the next question which of the following finding is not used as a criteria to classify preeacclampsia as severe among this which do you not use as a criteria for preeacclampsia among these ones the one which is never used as a criter criteria is proteinora. Proteinora does not affect severity. See, I will use the level of protein only to detect if I'm dealing with a gestational hypertension or a preeacclampsia. Chronic hypertension or a chronic hypertension with superimposed preeacclampsia. Once you have done that classification, that naming that terminology is given then for further followup there is no role of proteinura. There is no role of proteinura. One more update that has happened. Previously we used to use IUGR and ooligura to detect a patient as severe. Now they are telling don't use oligura. Don't use IUGR for detecting again severe preeacclampsia. So best answer is proteinura. Next best answer that you can choose is IGR and ooligura.

[00:11:26]These two has been recently removed as well. Yes. So apart from this presence of pain in the upper quadrant, this is mainly the right upper quadrant pain which is associated with stretching of the liver capsule. It is an impending sign. Headache, blurring of vision again comes in impending sign. Blood pressure more than 161 again is pointing towards severe. We have discussed all the features of severe. Yes, what were the features of severe? BP more than 161.

[00:11:54]Any feature of end organ damage, any symptoms suggest you have impending eclamsia such as headache, blurring of vision, epigastric pain, nausea, vomiting, all these come under severe hypertension.

[00:12:07]Systolic blood pressure more than or equal to 160. Diastolic blood pressure more than or equal to 110. Impending eclampsia signs such as headache.

[00:12:17]Blurring of vision.

[00:12:20]Epigastric pain.

[00:12:25]This is not ideal epigastric pain. This is right upper quadrant pain. Increased liver enzymes as ALT more than or equal to 70. platelet less than one lakh per deciliter creatinine more than 1.1 migram per deciliter or presence of pulmonary radiia IUGR they are recently removed from severity classification so this you can remember in the end as plus minus they are recently removed yes let's go to the next question again a very important concept from our CA surveys a 35year-old woman is diagnosed with carcinoma cervix and on hystopathology you are seeing that depth of lesion is 4 mm with a horizontal spread of six. There is no desire for future fertility. Imaging shows no parametrical involvement. What is the most important management for this patient? First tell me guys which stage am I dealing with? Is it 1 A1, 1 A2 or 1 B1? Which stage am I dealing with?

[00:13:34]Yes, it is 1 A2. You will see two values over here. One is 4 mm, one is 6 mm.

[00:13:43]What am I actually concerned about?

[00:13:45]Depth of invasion. What we discussed previously? 1 A1 1 A2 1 B1 1 B2 1 B3 less than 3 3 to 5 mm less than 2 cm 2 to 4 cm and more than 4 cm. It is depth of invasion. So don't get confused with it.

[00:14:06]They might give you horizontal spread.

[00:14:08]It is the depth of invasion. If at all depth was actually 6 mm then which stage would it have been? If the depth was 6 mm then it would have been 1 B1. Don't look at six. Yes 1 B1. Here I'm dealing with someone who is 182 because depth is 4 mm. So indirectly I'm asking you what is the management of 18 A2. We already discussed this yesterday. 1 A1 with no lymphovvascular inhibition was type one hyerectomy. Next two people that is 1 A1 with lyovascular space ination and 1 A2 is type two hyerectomy. From 1 B1 whatever is there then comes your type three hyerectomy. 1 B1 1 B2 and 2 A1 was type three hyerectomy. So simple hyerectomy I would do in 1 A1 without LVSI.

[00:14:55]I will do modified radical hyerectomy with pelvic lymph node dissection in 1 A2 and 1 B1. Radical hyerectomy and pelvic lymph node dissection in 1 A2 is here it is 1 A1 with lymphovvascular phase invasion and 1 A2 I will go for radical in case of 1 B1 1 B2 and 2 A1 rest everything whatever is remaining is concurrent chemo radiation that is 1 B3 3 and 2 A2 till 4 I will go for concurrent chemo radiation. Yes, that's a nutshell in the management. Very important as as such.

[00:15:44]Yes, SA can you please tell me what is the doubt? Are you confused with this diameter here or the depth which is there? They might give you lateral spread. They might give you depth. What we describe over here is mainly the depth of invasion. Here clinical scenario is giving you she is 4 mm deep lesions are there. She's having 4 mm deep depletions. This comes in 182. Four is between 3 to 5. It is coming in 182.

[00:16:14]Yes. Is that clear?

[00:16:17]Clear for everyone? Do you want me to repeat any aspect of it once again?

[00:16:22]Yes. Clear. Okay. Good.

[00:16:25]Can we move to the next question? Is the speed okay? Do you want me to slow down a bit or is this piece okay? I'm I'm going at this speed because very recently last two days we have been discussing the same thing. Discuss same thing once again might bore you. That's why I can slightly increase it also if you want. But definitely do tell me if you want to decrease. Okay. Before proceeding further increase slightly, right? Okay. Increase. I feel so too because you know these things we have discussed it very recently. Yes.

[00:16:51]Whatever is new, we will take a bit of time related to that. All right. Let's move to this question which is based on various scorings that we used in various gynecological conditions. Where is Nugan score used? Nugen score is mainly used for bacterial vaginosis. Where is ceraman gallery scoring is used? It is used for cursupism. Where is read score used? It is mainly used for culposcopy that is mainly to assess the cervical intrapithelial neoplasia or cancer which is present as such. And finally where do you use Cooperman's score? This is mainly used in case of menopausal female to assess the severity. Even if you miss on one of the score maybe you did not know this Coopermanman score is there still you can come to the answer by just looking at the other option. So don't leave the option even if one of it is difficult don't leave the question completely. Yes. So one thing extra that I'm teaching you over here this Cooperman score is mainly used for menopausal symptoms. It is used for menopausal symptoms. So that's it. A4 Newan score is herutism. Finally uh the feriman gallop nugan score is mainly for bacterial vaginosis.

[00:18:02]Yes. Nugan score is for bacterial vaginosis. Feriman gallery score is for herism. The reed score is for c and cooperman man score is for the menopausal symptoms. Menopausal symptoms. The other two are given extra along with it. Yes. These are the various scorings that you have.

[00:18:22]Let's have a look at this image based question. Simple image you are seeing a highman with a separation in between.

[00:18:28]This is septate highman. These are the various other types of himman abnormalities without any perforation.

[00:18:34]Imperate him highman small annular opening annular highman. You are seeing small seam like opening cribform himman and even a paris o. This is a paris o.

[00:18:44]You can see this small small projections which is there which is known as meritive form kangles a small small nodularity which is there this is a paris simple image based question yes now regarding this leopo's maneuver a pregnant female has come to a 36 week 37 weeks which leop's maneuver is being performed here this is something which we very commonly do in the clinics as well to check how the baby basically ally is the first one. What I will do is I'll keep my hand at the fundus. The funal grip also known as first leopold's maneuver. The funal grip. The second leopold's maneuver I'm going to keep on the either sides. I'm going to check where the back of the baby is. This will again tell me what is the position of the baby. Second is also known as umbilical grip.

[00:19:42]Umbilical grip. In third Leopold's maneuver, I'll keep it at the just above pubic symphysis and I will feel what part am I feeling. Is it head? Is it breach? So again it will tell me what is the presentation of the baby. It can help to determine again whether the baby has gone down into pelvis. Whether the baby's head is engaged or not that is the third leopold grip which is shown over here. Finally in fourth grip what I will do is this is how the fourth grip looks like. Instead of facing the face of the woman. Suppose the mother faces here. I'll just turn to this side and I'm going to face like this and keep my hand like this. This will again tell me what is the presentation. If it's a palic breathes, it will tell me whether baby's head is engaged or not. Suppose both my hands are converging like this.

[00:20:26]That means the head is uh converging means head is not engaged. If the head has gone down, my hands will be diverging. It can even tell what is the attitude of the baby whe the baby's head is completely flexed extended all these things you can get from the fourth leopold grip. So when you compare this grip first can tell you regarding presentation the lie the second can tell you about position that is whether back is anterior posterior.

[00:21:02]Third will again tell you what is the presentation whether head is engaged or not.

[00:21:14]Fourth can confirm these findings. It will confirm the findings that you got in third grip and it will even tell me what is the attitude of the baby.

[00:21:33]It will even tell me what is the attitude of the baby. How to tell the attitude? When is that baby? Baby is okay. It will even tell me the attitude of the baby. Just have have a look here.

[00:21:49]Suppose I do the examination and I'm feeling that the sephalic prominence.

[00:21:54]What is meant by this sephalic prominence? system the prominent part that I feel during this first prominent part that I feel during the examination you have completely flexed it the sinciput is the sephalic prominence that you're going to feel occiput is more down if you feel that the sephalic prominence is on the opposite side of the back what is the attitude of the baby tell guys what are you seeing here this is the first prominence that you're feeling it is on the opposite side of the back means the head is completely flexed Suppose baby's head is completely extended like this. I will feel the sephalic prominence which is occiput on the same side of the back. This is basically yes your completely extended face extended presentation completely extended. What is the presenting part?

[00:22:43]It will be face is the presenting part.

[00:22:47]If you find that both of them are felt at the same level that is the syphalic prominence both the centiput as well as oxiput it is felt at the same level it is usually a partially extended head so it can even help you to identify the attitude of the baby as well. Yes. Is that clear? Do you want me to show it in full this thing full this one rather than on the small screen? Yes. Clear. So we'll go to the next question.

[00:23:15]Clear. Completely clear. Yes. Yes. So it can even tell you attitude. So they can ask you this which of the following attitude engagement all those things position all these things with each of these maneuver what we do commonly in clinics. Now in the next question which of the following components of management of third stage of labor is most critical for preventing postpartum hemorrhage. If you have to choose one step the most important step is giving utrotonics. We usually give 10 international units intramuscular within 1 minute of delivery. We give 10 international units intramuscular intramuscular within 1 minute of delivery. But now there is a small update again in the latest WHO 25 2025 update they are telling if IV access is available.

[00:24:07]If I access is available you can even give 10 international units slow IV.

[00:24:17]You can even give 10 international slow IV. So traditionally we used to say IM.

[00:24:22]If IV access is there even you can even even you can give it as IV that is slow IV 10 international units. So first is utonics. Next comes the control cord traction and delayed cord clamping.

[00:24:35]Finally what is not done? Utrine massage is not a part of AMTSL assist. Fundal pressure we never give early cord clamping not a component. Utrine massage was previously a component. Now they are telling only if tone is reduced then you go for uterine massage. Tone is normal no need of uterine massage. They can even ask you an all except question like the last INI exam. So have a note of those components.

[00:25:03]All right. So in this next question, a 58-year-old postmenopausal female presents with bleeding for the past 2 months. She is obese and has longstanding history of type 2 diabetes.

[00:25:14]She has irregular menstrual cycles prior to menopause. Endometrial biopsy shows a well differentiated malignant tumor arising in the background of endometrial hypoplasia. Which among the following is most likely seen in this patient.

[00:25:27]Indirectly they are asking you which among the following is the most common type of endometrial cancer. Most common type is endometrioid which is also described as type one endometrial cancer. Whereas all these the clear cell the cirrus all these are more malignant.

[00:25:45]It comes in type two. Endometrioid is type one. This is the one that we typically describe which is estrogen dependent which is seen in obese females which is associated with endometrial hypoplasia and it has good prognosis.

[00:26:09]It is well differentiated associated with good prognosis. Whereas type two you can have even in thin female with an atrophic endometrium as well. Again if they give you a scenario based question if they give you postmenopausal bleeding simply postmenopausal bleeding first differential that should cross your mind is CA cervix and for CAS cervix I would have done a speculative examination but if they give you these associated features postmenopausal bleeding associated with hypertension diabetes malitus obesity think about corpus cancer syndrome and the main differential that will cross your mind is CA endometry and if they make it Scenario based question. Patient has come with postmenopausal bleeding who has hypertension, diabetes, obesity. What will you do next for the patient? One option is speculum examination. One option is TVS. What will you do next?

[00:27:04]Speculum or TVS. Postmenopausal bleeding, hypertension, diabetes, obesity, TVS or speculum. Do TVS because this corpus cancer syndrome triad is there. Simple case of postmenopausal bleeding. Please first choose your answer as speculum examination. If they give you this corpus cancer syndrome that is hypertension, diabetes, obesity, corpus cancer syndrome.

[00:27:31]In that scenario please choose TVS and even TVS I see that endometrial thickness is more than 4 mm. I will proceed with endometrial biopsy. the step-wise evaluation of postmenopausal bleeding that we discussed yesterday.

[00:27:49]So this endometri type is the most common malignant variety. It is estrogen dependent. It is well differentiated. It expresses estrogen has good prognosis and risk factors such as obesity, diabetes and ovulation. Anything associated with high estrogen is associated with your type one endometrioid type.

[00:28:10]All right. Moving to the type of pelvis which is associated with phase to pubis delivery. Which pelvis is associated with face to pubis delivery? Anthropoid type of pelvis. How to identify anthropoid type of pelvis? It is anthroposteriorly oval. The first one is round. It is gyneid. Second one is heart shape. The android.

[00:28:34]The third one is flat platty.

[00:28:39]The final one is your anthropoid.

[00:28:43]Final one is the anthropoid type of pelvis. Correct answer here is D. Next time I ask you which one is most commonly associated with deep transverse arrest. This will be your answer. Which among the following is most commonly associated with face presentation? Your answer will be platypical type. Which among the following is most commonly associated with OP android type. Which among the following is associated with persistent OP anthropoid type? Which among the following is most common or most favorable for a vaginal delivery? Your answer is the gynecoid type of pelvis.

[00:29:25]All right, moving to the next question. A 30-year-old woman presents at 35 weeks with acute onset of breathlessness. So, she's having sudden onset of breathlessness at 35 weeks. On examination, uterus is over distended and it is tense. Ultrasound confirms severe body hydramus. Patient is having market respiratory distress. Baby's heartbeat is reassuring. What is the most appropriate management for this patient? I'm dealing with polyhydramus.

[00:29:53]Main management reduce that is gradual reduction of this amniotic fluid. Amno reduction or therapeutic amnocynthesis.

[00:30:01]If same question baby's heart rate was not reassuring it was nonreassuring I would have gone for delivery of the person. Any case where you have fetal distress deliver as soon as possible. No role of intravenous fioomide or saline infusion artificial rupture of membrane.

[00:30:17]If at all you are rupturing the membrane during the time of delivery I will go for controlled rupture of membrane.

[00:30:24]During rupture of membrane there is high risk of cord prolapse and also abruption and also abruption as well.

[00:30:40]Yes, this question is from Figo classification of fibroid. They're giving you that you have done a saline infusion somography imaging reveals a sub mucosal fibroid projecting into endometrial cavity with that less than 50%age of it extending into myometri according to the figo staging which type of fibroid is it yes let's learn this different types of fibroid as per the figo staging just remember like this as we go from 0 to 8 I'm going from inside of the uterus this is completely inside by the time I reach seven it goes outside eight means completely outside the other sides as is we are moving from inside out outwards zero is sub mucosal which is pedangulated with as a connection one means sub mucosal with a little component within the muscle less than 50% is intramural as you can see here which was given in the question type one less than 50%age intramural type two more than 50% is within the muscle more than 50%age intra Intramural type three and four are intramural.

[00:31:48]Three remember T for T. Three is touching the endometrium or in contact with endometrium. Four is completely intramural not touching anywhere. 5 6 7 Remember subzero cell. Five 6 7 subzero cell. Five more than 50%age is intramural. Six less than 50%age is intramural. Seven pedulated. Okay. 5 6 7 is subosal. uh less more than 50%age less than 50%age and pedangulated just take it away from the uterus that's it finally you have eight eight means all others such as broad ligament fibroid cervical fibroid your parasitic fibroid all these come in type eight all these come in type eight even wandering fibroid sometimes this fibroid likes to go around it'll go around attach somewhere and derive blood flow from there that is known as the wandering fibroid or the parasitic fibroid Yesterday we had seen how to differentiate between the different types of broadle ligament pseudo and true broad ligament fibroid. Another point that you can remember related to cervical fibroid is the cervical fibroid. It looks like the uterus is sitting on top of this huge fibroid.

[00:33:01]This appearance is known as lantern on Saint Paul's cathedral.

[00:33:06]This appearance is lantern on St. Paul's Cathedral.

[00:33:20]Lantern on St. Paul's Cathedral appearance which is associated.

[00:33:32]Yes. Is the figure staging clear?

[00:33:35]This is a slightly difficult question as such. Unless you revise it or very closely you might have found a bit difficult to answer this. I hope it is clear now. Just start from inside go out outwards from zero and finally by the time you reach eight take it completely outside. Remember that 0 1 and two along with sub mucosal pedangulated less than 50% intramural more than 50% interrome then remember three and four together T40 T three is touching the endometrium or in contact with endometrium four is completely intramural. Then remember 5 67 all sub zero cell five more than 50%age interal six less than 50% seven pedigulated eight is completely outside is parasitic wandering fibroid yes okay so here correct answer they're telling you less than 50%age your answer is type one let's move to the next question so this is a radopediatric gy correlation I would say a 40-year-old female has presented with an ultrasound this is polyhydramio associated with This sign what are you seeing there? This is the double bubble appearance which is associated with diodinal atricia and we have seen this diodinal atricia. Yes the 3Ds double bubble sign diodinal atricia associated with down syndrome. It is associated with down syndrome. Theodinal atricia double bubble sign and yes the down syndrome. The three Ds that you can remember together.

[00:35:04]Another sign that you can remember here suppose they give you oligo hydram case and they giving you a sign like this.

[00:35:11]The bladder looks like this like a keyhole. The keyhole is then where you put this keyhole sign. Yes.

[00:35:20]Keyhole sign. What will you think about puv posterior urethral valve? Yes, male baby they will give you this posterior urethral valve can be associated with a keyh hold sign. Let's have a note of that as well.

[00:35:38]Identify the instrument that is shown below. What type of forceps? One of the students had message I was finding a bit difficult to identify the forceps. What is the first thing that comes to your mind when you see this forceps?

[00:35:50]Yes, it looks slightly bent. It has this reverse curve which is there over it.

[00:35:56]This reverse pelvic curve is associated with your piper forceps. In kan's hospeps you will see that special lock.

[00:36:03]If you see a very so too small instrument that dwarf kind of instrument that is a wrigly forceps that short instrument Simpson slightly longer than that your wrigl forceps. So this is piper's forceps in breeds for head delivery in breeds. We have seen the various maneuvers for the other maneuvers for delivering the head as well. We saw this maneuver. What was this? This maneuver where the baby can smell very close by. You are putting this. Yes. This is your Moraicio smelly wheat maneuver. You saw the maneuver where I'm doing that martial art. I'm shifting the baby like this. I am turning the baby in an arc across the maternal abdomen. Excellent answer. This is burned marshall technique. Burn marshall technique. We saw the maneuver for extended leg. You give this pressure on fossa. You flex and deliver out the leg. The pinat's maneuver. You saw the maneuver where I just rotate the baby.

[00:36:55]Yes. Boom. Baby pur. Yes. Lousets maneuver. You rotate in 180° and again 180° to deliver the extended arms. The L sets manure. Yes. Very good. Excellent guys. Yes. Finally. So another maneuver not for breeze. I'll put my entire hand inside catch hold of the feet from somewhere. Bring the other hand down and bring the baby down like this. Internal podalic motion. The internal podalic portion. Second twin for second twin in transverse life. The IPV for second twin in transverse life.

[00:37:30]All right, let's move to this next question. A 30 year old primary gravida presents a 20 week of gestation. She's undergoing ultrasound. It shows that there is low placenta extending up to us but not covering the internal loss. Her vitals are stable, hemoglobin is normal. What will you do next for this patient as such? What are you going to do next for this patient? Majority of the cases 80 to 90%age placenta will move upwards.

[00:37:56]You just have to repeat the scan. You will repeat the ultrasound by 32 to 34 weeks. There is no need to do MRI. You just do repeat ultrasound. If you have to choose an answer, answer is 32. Then again you repeat at 36 weeks. If still it is present at 36 weeks also then you can proceed with ceilian section. I would have given her steroids along with mcafey Johnson's regimen. If patient has presented with bleeding along with me you can give corticost but not in this scenario she has come with bleeding you are expecting a delivery preter you can think of that allow for spontaneous labor that I'll never do in case of placenta privia less privia is always CS if you go for vaginal delivery you kill the mother and the baby okay it's always CS here correct answer is C correct answer